A new PNAS paper “Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates” provides evidence of the power of plan-making in getting a flu vaccine shot (Full copy here. Hat tip: Prashant Srivastava). In an experiment, random sets of employees received a mailing that asked them to write down the date they planned to be vaccinated or the date and time they planned to be vaccinated. The first plan-making prompt didn’t work. The second did.

Vaccination rates increased when these implementation intentions prompts were included in the mailing. The vaccination rate among control condition employees was 33.1%. Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group, a difference that is not statistically significant. Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate, a difference that is both statistically significant and of meaningful magnitude.

Public health officials may be the ones most likely to read this study, but marketers at pharmacies should see a possible business opportunity here. When a customer arrives to pick up a prescription, a pharmacist could easily offer a flu shot, give the customer a piece of paper, ask them to make a plan, and tell them to take that plan with them and post it at home on their calendar.

We recently blogged about a behavioral economics gym membership plan in which people pay more money if they don’t visit the gym. A commenter said that a similar plan already exists at the SF Bay Club in San Francisco where members must “swipe in 8x/month or pay more that month.” This doesn’t quite appear to be the case, at least according to the staffer who answered the phone when the Nudge blog called. The club does appear to use behavioral economics principles in its gym memberships, however. Here are two nice examples:

1) Last year, the club offered local companies a membership package for their employees in which an employee would receive a discount off the standard membership rate if they used the gym at least eight times a month. This seems to be the membership plan the commenter was referring to.

2) The club has also instituted a new years resolution promotional plan. Gyms frequently get a membership boost at the start of the new year as people make plans to work out more. Typically, people give up on their resolutions and those memberships end after three months. To fight that phenomenon, the club offers $50 in credit that can be applied to future dues for every 10 gym visits the new member makes. You have to visit the gym before March 15th, and you get credit for a maximum of 30 visits (for a total of $150 – you can, of course, visit the gym as much as you want). The idea behind the plan is to get people into the gym more often so that they are less like to drop the membership after the usual three month run. It’s an interesting idea that will be worth following up on.

Two Harvard students use behavioral economics to reinvent the gym membership.

Gym-Pact offers what Zhang calls motivational fees — customers agree to pay more if they miss their scheduled workouts, literally buying into a financial penalty if they don’t stick to their fitness plans. The concept arose from Zhang’s behavioral economics class at Harvard, where professor Sendhil Mullainathan taught that people are more motivated by immediate consequences than by future possibilities.

“If you have a toothache, you go to the dentist. If there’s a cavity, you know it needs to get filled in, but if it doesn’t hurt right now, you may not bother,’’ Mullainathan said. “In traditional gym memberships, not going is not very costly. In this one, you actually might feel the pain of not going immediately.’’

Zhang and Oberhofer translated that principle to workout motivation. If missing a workout cost people money, they’d be more motivated to stick with it, they thought.

Details on two pilots with Bally Total Fitness and Planet Fitness in Boston are in the Boston Globe.

The NYT opened up a forum for people to submit ideas on default rules that could be changed. One idea, proposed by a reader in “KC”, that Tina Rosenberg found interesting was around health care appointments.

“When signing up for a health plan, it might be effective to have to opt-out of preventive treatments, such as an annual checkup. I never went for my annual checkup when I was younger because it required researching a doctor and scheduling an appointment. I would have gone to a checkup if I was given a default doctor and had an appointment scheduled for me.”

Choosing a doctor can be a personal choice, which seems like a good reason for resisting switching this default rule for some. But HMO plans have made medicine far more impersonal than it was a generation ago. And with people moving to new cities and need to find new physicians, it might be a default rule switch worth looking into for some patients. The default rule switch need not be some elaborate set up taking into account various preventative procedures. It could be as simple as this: When you sign up for a new health plan, a primary care physician close to your work or home is chosen for you and one appointment is scheduled within the coming few months. You are provided with a number to call to cancel the appointment or to switch doctors.

That’s the policy at Burgerville, a Pacific Northwest burger chain. The CEO explains the new receipts to Fast Company.

“It started first with guests interested in customizing our food. For those who have allergies or are health-conscious, how do they know if they’re on track or not?” Burgerville CEO Jeff Harvey tells FastCompany.com. So Harvey did some research on Nutricate, a system from SmartReceipt that offers personalized nutritional information on receipts. The system is already used in many hospitals and employee cafeterias, but Burgerville is the first fast food chain to adopt it.

Burgerville’s receipt system doesn’t just shock customers into making different food choices–it also suggests what some of those choices might be. “One of our signatures is a real ice cream milkshake with seasonal fruit–it has the best quality ingredients, coming straight from the farms, but the calorie count could be as high as 800 calories. So guests will get a recommendation saying, for example, if you like the blueberry shake, you might consider getting a blueberry smoothie next time,” Harvey says.

About

The Nudge blog is the online companion to Richard Thaler and Cass Sunstein’s “Nudge: Improving Decisions About Health, Wealth, and Happiness.” Here you’ll find much more about nudging, choice architecture, libertarian paternalism, and many other terms you won’t read about in standard economics books.

Cass Sunstein is currently the Administrator of the White House Office of Information and Regulatory Affairs and has no affiliation with the Nudge blog.

The Nudge blog is edited by John Balz.

Tell us about a nudge

The possibilities for great nudges are everywhere. For a list of favorites from the book, check out our dozen nudges. We invite readers to send their own nudge suggestions to nudgeblog@gmail.com.

What is Choice Architecture?

Decision makers do not make choices in a vacuum. They make them in an environment where many features, noticed and unnoticed, can influence their decisions. The person who creates that environment is, in our terminology, a choice architect. The goal of Nudge is to show how choice architecture can be used to help nudge people to make better choices (as judged by themselves) without forcing certain outcomes upon anyone, a philosophy we call libertarian paternalism. The tools highlighted are: defaults, expecting error, understanding mappings, giving feedback, structuring complex choices, and creating incentives.

For a user-friendly introduction to choice architecture, check out this paper.